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5 Quality Components for mLTSS

Managed Long Term Services and Supports (mLTSS) refers to the delivery of long-term services and supports through Medicaid managed care programs. mLTSS’s strategy is to expand home and community-based services, promote community inclusion, ensure quality, and increase efficiency. Indiana is implementing its own version of mLTSS to Skilled Nursing Facilities rate effective date 7/1/2024.

Many changes are occurring and we will cover all of them, but one major (and monetary) change with come in the form of recalculating the quality component of the rate and wrapping it up with facilities UPL. Below we have listed the quality components that will be used to calculate your quality score and then assign you a percentage of the $ amount assigned for that fiscal year.

5 Quality Components for mLTSS.

Percentage of Long-Stay Residents Experiencing One or More Falls with Major Injury

This quality measure is residents with one or more falls with a major injury reported in the target period or look-back period. The look back periods for this quality measure is 275 days. The Resident Assessment Instrument RAI Manual defines a fall with major injuries as a bone fractures, joint dislocations, closed head injuries with altered consciousness, subdural hematoma.

Percentage of High Risk Long-Stay Residents with Pressure Ulcers

These are long stay residents who are determined to be high risk with a Stage 2, 3, or 4 pressure ulcer or unstageable pressure ulcers are present. “High risk” definition:

  1. Impaired self-performance in bed mobility or transfer (from section G)
  2. Comatose
  3. Malnutrition or at risk of malnutrition

Effective October 1, 2023 this measure is replaced with a new measure “Percent of Resident with Pressure Ulcers,” due to the removal of section G in the MDS. On the April 2024 Care Compare refresh it will be frozen until it is replaced with the new measure Precent of Resident with Pressure Ulcers on the January 2025 refresh.

Number of Hospitalizations per 1000 Long-Stay Resident Days

The long-stay hospitalizations measure determines the number of unplanned inpatient admissions or outpatient observation stays during a one-year period for permanent residents. This data shows up on Medicare Claims submitted by the facility or hospital and will be averaged over the past four quarters.

Number of Outpatient Emergency Department Visits per 1000 Long-Stay Resident Days

Outpatient ED visit measure determines the percentage of long-stay residents who have had an outpatient visit to the ER. When looking at this measurement, the higher the value, the worse the performance is. This data shows up on Medicare Claims submitted by the facility or hospital and will be averaged over the last four quarters.

Total Nurse Staffing Ratio

This measure includes:

  • Total nurse staffing hours per resident per day
  • Respiratory therapy hours per resident per day
  • Case-mix total nurse staffing hours per resident per day

This data is pulled from the quarterly Provider Based Payroll Journal (PBJ). As quality measures evolve over time, staffing is playing a larger role than it did before.

Key Takeaways

It has become evident that charting/MDS, billing, and payroll/staffing tracking is becoming more important. Being able to detect and iron out abnormalities with current data will be key to make sure the above components are reported correctly and optimally.

Contact Us bout mLTSS

Our Post Acute Care team at Blue & Co. has the expertise necessary to ensure your facility is prepared for these changes. If you have any questions, please reach out to one of our experts below or your local Blue & Co. Advisor.

Kayla May, CPA, Manager

Stephanie Fitzgerald, RN, RAC-CTA, CPC, Manager

Landon Hackett, CPA, Director

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